AbstractBackgroundFrequent blood glucose tests are performed for people with diabetes receiving haemodialysis.ObjectivesTo determine the rate of out‐of‐range post‐haemodialysis blood glucose levels that are clinically acted upon, the intervention and outcome of each intervention, and the associations between post‐haemodialysis blood glucose levels and relevant clinical predictors.Design12‐month retrospective cohort medical record review in one Australian haemodialysis centre. Post‐haemodialysis blood glucose levels, prehaemodialysis blood glucose levels, time of treatment, diabetes medications, intradialytic fluid removal, dialysate dextrose concentration, clinical actions, interventions, and outcomes on out‐of‐range blood glucose levels were retrieved.Participants22 participants with a median time receiving dialysis 3.1 years (interquartile range 2.3−4.7).Measurements and ResultsThe proportion of out‐of‐range post‐haemodialysis blood glucose levels was 87.3% (95% confidence interval, 86.1%−88.5%). No out‐of‐range post‐haemodialysis blood glucose levels were clinically acted upon. Out‐of‐range post‐haemodialysis blood glucose levels were 4.6 times more likely if a higher dextrose bath was used (95% confidence interval: 3.3; 6.3. p < 0.001). The odds of the post‐haemodialysis blood glucose levels increased by each 1 mmol/L. Intradialytic fluid removal, dialysate dextrose concentration, sex, dialysis time, anti‐hyperglycaemic agents were also associated with out‐of‐range post‐haemodialysis blood glucose levels.ConclusionRoutine post‐haemodialysis blood glucose levels testing has limited clinical utility in care for people with diabetes receiving maintenance haemodialysis. Higher dextrose dialysate may require individual titration depending on prehaemodialysis blood glucose levels.

2024-11-01·Digestive Diseases and Sciences

Prophylactic Proton Pump Inhibitors in Upper Gastrointestinal Bleeding: Impact and Underprescription in a French Multicentric Cohort

Article

作者: Boualit, Madina ; Polin, Vanessa ; Bertolino, Jean-Guy ; Trompette, Marie ; Arondel, Yves ; Elriz, Khaldoun ; Zanditenas, David ; Louvel, Dominique ; Quartier, Gilles ; Bocci, Massimo ; Ehrhard, Florent ; Berger, Chantal ; Charpignon, Claire ; Pauwels, Arnaud ; Alabert, Frédérique ; Guerbau, Loïc ; Mace, Vincent ; Meszaros, Magdalena ; Billet, Gaëlle ; Bellon, Serge ; Paupard, Thierry ; Arotcarena, Ramuntcho ; Vandamme, Hélène ; Faroux, Roger ; Remy, André-Jean ; DE Lustrac, Mercedes ; Pateu, Etienne ; Coulibaly, Baya ; Talbodec, Nathalie ; Delobel, Jean-Bernard ; Skinazi, Florence ; Kaassis, Mehdi ; Vitte, René-Louis ; Lam, You-Heng ; Garceau, Cécile ; Garioud, Armand ; D’hautefeuille, Gaëlle ; Cuen, David ; Aziz, Karim ; Combes, Rémi ; Barjonet, Georges ; Arpurt, Jean-Pierre ; Nobecourt, Amélie ; Davy, Hortense ; Zavadil, Patrick ; Geagea, Edmond ; Zaharia, Oana ; Prieto, Marc ; Borel, Isabelle ; Locher, Christophe ; Esch, Anouk ; Petiet, Mathilde ; Macaigne, Gilles ; Wartel, Faustine ; Salvati, Thierry ; Vickola, Joseph ; Haque, Jessica ; Chelly, Jonathan ; Koudougou, Carelle ; Schnee, Matthieu ; Heresbach, Denis ; Berete, Aliou ; Quentin, Vincent ; Leblanc-Boubchir, Rachida ; Agnello, Christophe ; DE Montigny-Lenhardt, Stéphanie ; Costes, Laurent ; Lagin, Ludovic ; Tsakiris, Laurent ; Bramli, Slim ; Boutroux, Dominique ; Pennec, Olivier ; Horaist, Clémence ; Dobrin, Anca-Stela ; Baconnier, Mathieu ; Kerneis, Jean ; Pinard, Fabien ; Barge, Sandrine ; Lemee, Delphine ; Verlynde, Juliette ; Harnois, Florence ; Bellecoste, Marie ; Bideau, Karine ; Thiebault, Quentin ; Herrmann, Sofia ; Fares, Eddy ; Baudon, Julien ; Legruyer, Antonia ; Nahon, Stéphane ; Benezech, Alban ; El Hajj, Weam ; Vanveuren, Charlotte ; Colin, Marie ; Pelaquier, Agnès ; Bauguion, Lucile ; Touze, Ivan ; Laly, Margot ; Heluwaert, Frédéric ; Senouci, Leila ; Catala, Pascale ; Lubret, Henri ; Grasset, Denis ; Maillard, Emmanuel ; Moussaoui, Mohammed Redha ; Fron, Mathilde ; Amil, Morgane ; Rosa, Isabelle ; Ripault, Marie-Pierre

BACKGROUNDAppropriate prescription of Proton pump inhibitors (PPIs) remains an important concern amid the rising overuse. A gap exists in the literature regarding the benefit of PPI prophylaxis and the consequences of underprescription in patients at risk for upper gastrointestinal bleeding (UGIB).AIMSThis study aims to describe the characteristics of hemorrhage in relation to PPI use in patients experiencing UGIB, with a focus on high-risk individuals requiring gastroprotection.METHODSData from a French multicentric cohort of patients experiencing UGIB were analyzed. Patients using PPI were compared to those without PPI considering bleeding etiologies and outcomes of peptic ulcer disease (PUD)-related hemorrhage. The rate of PPI use and its effect on bleeding characteristics in high-risk populations, defined based on international guidelines, were also assessed.RESULTSAmong 2497 included patients, 31.1% were on PPI at bleeding onset. PPI users exhibited a significantly lower rate of PUD-related bleeding in comparison with those without PPI (24.7 vs 40.8%, respectively, p < 0.0001). Similar difference was observed in high-risk populations, of whom, only 40.3% had gastroprotection with PPI before bleeding onset. PPI prophylaxis, however, did not influence the severity of bleeding in the general study population or in high-risk groups. Multivariate analysis identified age, comorbidities, and having more than two anti-thrombotic agents as predictors of severe bleeding.CONCLUSIONSPPI users appear to have a lower rate of bleeding ulcers compared to non-users. However, underprescription in high-risk groups raises the need for standardized care to ensure appropriate PPI use.

2024-10-01·European Journal of Internal Medicine

Relationship between degree of risk factor control and all-cause mortality in individuals with type 2 diabetes: A prospective cohort study

Article

作者: Nicolucci, Antonio ; Vitale, Martina ; Fondelli, Cecilia ; Bonora, Enzo ; Solini, Anna ; Vedovato, Monica ; Pugliese, Giuseppe ; Garofolo, Monia ; Resi, Veronica ; Orsi, Emanuela ; Trevisan, Roberto ; Penno, Giuseppe

AIMSTo assess whether and to what extent excess risk of all-cause death is reduced in individuals with type 2 diabetes by achieving optimal control of traditional cardiovascular risk factors.METHODSThis observational, prospective, cohort study enrolled 15,773 Caucasian patients in 19 Italian centres in 2006-2008. Participants were stratified according to the number of the following risk factors outside target: haemoglobin A_1c, blood pressure, micro/macroalbuminuria, current smoking, LDL cholesterol, and triglycerides. All-cause mortality was retrieved for 15,656 patients (99.3 %) on 31 October 2015.RESULTSAge-adjusted mortality rates and hazard ratios were significantly higher in the whole RIACE cohort (by ∼20 %) and in patients with (by ∼100 %) but not in those without prior cardiovascular disease (CVD), as compared with the coeval Italian general population. In all patients and in those without prior CVD, the relationship with mortality according to the number of risk factors outside target was J-shaped, an effect that was attenuated after either excluding "overtreated " patients, i.e., those with haemoglobin A_1c ≤6.0 % on anti-hyperglycaemic agents causing hypoglycaemia and/or systolic blood pressure ≤120 mmHg on anti-hypertensive agents, or adjusting for "overtreatment". Conversely, in patients with prior CVD, mortality remained higher than in the general population in all categories and increased progressively from +70 % to +314 %, without J-effect.CONCLUSIONSIn patients with type 2 diabetes, optimal treatment of traditional cardiovascular risk factors completely eliminated the excess mortality risk versus the general population, provided that they were not "overtreated". However, this effect was observed only in participants without history of CVD.TRIAL REGISTRATIONClinicalTrials.gov, NCT00715481, retrospectively registered 15 July 2008.

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